gangrene - lms.kemu.edu.pk · and gas may be detected within the underlying tissues by physical...
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Gangrene
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Gangrene - Broad types
Dry Gangrene
(Ischemic Gangrene)
Wet gangrene
( infective Gangrene)
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Gas Gangrene
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anaerobes
G +ve
Endospore Rods
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• C. Perfringens
• Gram-positive, anaerobic, spore-bearing bacilli
• Widely found in nature, particularly soil & faeces
• Military And Traumatic Surgery And Colorectal Operations
• Immunocompromised, Diabetic Or Malignant
• Necrotic Or Foreign Material, Resulting In Anaerobic Conditions.
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• Clostridia produce a variety of biologically active proteins, including hemolysins, proteolytic enzymes, and other toxins
• Clostridia produce a greater diversity of toxins than any other genera of bacteria. These include neurotoxins, enterotoxins, collagenases, proteases, and other necrotoxins, lecithinases, lipases, DNAses, and neuraminidases.
• most lethal substances yet described; less than 0.2 ng of purified toxin is fatal in mice
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• Tissues causes a 'sucking' entry wound, leaving clothing and
• Environmental soiling in the wound in addition to devascularisedtissue
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• Within 24 to 72 hours after traumatic injury or surgery.
• Severe pain in the absence of obvious physical findings
• Redness at the site of the wound
• A rapidly spreading brown to purple discoloration of the skin is often seen.
• The progression is rapid, and within hours of the initial symptoms, edema and gas may be detected within the underlying tissues by physical examination, ultrasound, or radiographic evaluation.
• Hemorrhagic bullae may occur, along with a serosanguineous discharge
• Characteristic odor often described as “mousy.”
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• Neutrophils are often not seen on Gram stain due to the lethal nature of α-toxin for these polymorphonuclear cells.
• Leads to profound ischemia resulting from obstructed microvascular circulation
• Caused by platelet aggregation within vessels and fibrin deposition.
• These pro-ischemic properties are attributed to the α-toxin of C. perfringens and C. septicum, both of which have similar biologic activity.
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• The theta toxin of C. perfringens, perfringolysin O, may also act synergistically with α-toxin to decrease microvascular perfusion.
• The toxins can also result in systemic hematologic derangements such as disseminated intravascular coagulation.
• Fever is often minimal during the early stages of disease, but progression to full-blown sepsis with
• its classic hypotension, renal failure, and metabolic acidosis may set in rapidly.
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• Wound infections are associated with
• Severe local wound pain and crepitus (gas in the tissues, which
• May also be noted on plain radiographs).
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• Edema and spreading gangrene
• Release of collagenase, hyaluronidase, other proteases and alpha Toxin
• Circulatory collapse and
• MSOF follow if prompt action is not taken
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• Produces
• A thin, brown, sweet-smelling exudate